First national study to compare health of foster children vs others

Action Points

Living within the foster care system puts children at risk for poor mental and physical health.

Note that the results also showed that children placed in foster care were in worse mental and physical health than children in nearly every other type of family situation, even compared with children living in households below the poverty line.

Compared with the general population, children placed in foster care were five times more likely to have anxiety (14.2% versus 3.1%), six times more likely to exhibit behavioral problems (17.5% versus 2.9%), and seven times more like to be depressed (14.2% versus 2.0%), wrote study authors Kristin Turney, PhD, of the University of California, Irvine, and Christopher Wildeman, PhD, of Cornell University in Pediatrics.

The team also reported that foster care kids were more likely than children in the general population to have a learning disability (14.7% versus 7.6%), as well as problems with speech (11.2% versus 4.7%), hearing (3.9% versus 1.2%), and vision (3.4% versus 1.3%).

In an email to MedPage Today, Turney described the vulnerability of children in foster care as "striking."

She wrote: "These children experience more health problems than comparable children who are living in households below the poverty line. It is likely that children are coming to their foster care placements with health problems, likely as a result of the maltreatment and neglect they experienced in their homes of origin."

Turney and Wildeman collected data from NSCH -- a nationally representative survey of 95,677 noninstitutionalized children ages 0 to 17 years in the U.S. -- and reviewed interviews with the adults in the household, usually a parent, regarding the children in the sample.

Logistic regression models were then fitted to compare the parent-reported mental and physical health outcomes of children placed in foster care with the outcomes of children who were: not placed in foster care, adopted from foster care, in specific family types (i.e., single-mother households), and in economically disadvantaged families.

Children placed in foster care were more likely to be in fair or poor health and to have activity limitations than their general population counterparts, respectively (4.2% versus 3.1%) and (9.8% versus 4.8%). And while foster children were two to three times more likely to suffer from physical conditions, differences were even more substantial for mental health conditions.

Results also showed that children placed in foster care were in worse mental and physical health than children in nearly every other type of family situation -- even compared with children living in households below the poverty line, as well as those who were adopted from foster care. Of note, differences in mental health outcomes (attention deficit disorder/attention deficit hyperactivity disorder [ADD/ADHD], depression, anxiety, behavioral or conduct problems) were statistically significant.

"These differences could be driven partially by the fact that children in foster care only become available for adoption after parental rights have been terminated (and therefore these children have likely experienced more maltreatment than children who remain in the system) or because adoption subsidies offered in some states encourage adoption of children with health conditions," Turney and Wildeman wrote.

"Many of the differences in health persisted even after adjusting for a number of characteristics of the child and the child's household."

The study provided significant insight into the mental and physical health conditions of children in foster care, yet there were some notable limitations: the cross-sectional nature of the data and the limited sampling frame, which excluded children in group homes, as well as those who were institutionalized (i.e., were in juvenile justice system or in the hospital).

Additionally, the measures of children's health were reported by their caregivers: "Although an ideal survey design would measure physician-reported health and/or anthropometric measures of health, parent-reported children's health is correlated with physician-reported children's health and is often used when physician-reported measures are not available."

Looking forward, there is work to be done in addressing social determinants of health among children in foster care. "This is a vulnerable group that might require attention from pediatricians," Turney said.

The authors disclosed no potential conflicts of interest.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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